Healthcare Provider Details

I. General information

NPI: 1487680682
Provider Name (Legal Business Name): THERAPEUTIC INTERVENTIONS OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HOSPITAL DR W
WEST COLUMBIA SC
29169-3405
US

IV. Provider business mailing address

2315 CENTRAL AVE BUILDING C
AUGUSTA GA
30904-6272
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-5437
  • Fax: 803-794-5437
Mailing address:
  • Phone: 706-364-6172
  • Fax: 706-364-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER STEPHENS
Title or Position: OWNER
Credential: PHD, CCC-SLP
Phone: 706-364-6172